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COMMON TOXICITY CRITERIA (CTC) SCALE

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Grade
TOXICITY	0	1	2	3	4

Haematology
WBC (x10³/l)	4.0	3.0 - 3.9	2.0 - 2.9	1.0 - 1.9	< 1.0

Platelets (x10³/l)	WNL	75.0 - normal	50.0 - 74.9	25.0 - 49.9	< 25.0

Haemoglobin (g/dl)	WNL	10.0 - normal	8.0 - 9.9	6.5 - 7.9	< 6.5

Granulocytes/ Bands (x10³/l)	2.0	1.5 - 1.9	1.0 - 1.4	0.5 - 0.9	< 0.5

Lymphocytes (x10³/l)	2.0	1.5 - 1.9	1.0 - 1.4	0.5 - 0.9	< 0.5

Haemorrhage	none	mild, no	gross, 1 - 2 units transfusion per episode	gross, 3 - 4 units transfusion per episode	massive, > 4 units transfusion per episode

Coagulation
Fibrinogen	WNL	0.99 - 0.75 x N	0.74 - 0.50 x N	0.49 - 0.25 x N	< 0.25 x N

Prothrombin time (Quick)	WNL	1.01 - 1.25 x N	1.26 - 1.50 x N	1.51 - 2.00 x N	> 2.00 x N

Partial thrombo- plastin time	WNL	1.01 - 1.66 x N	1.67 - 2.33 x N	2.34 - 3.00 x N	> 3.00 x N

Metabolic
Hyperglycaemia (mg/dl)	< 116	116 - 160	161 - 250	251 - 500	> 500 or ketoacidosis

Hypoglycaemia (mg/dl)	> 64	55 - 64	40 - 54	30 - 39	< 30

Amylase	WNL	< 1.5 x N	1.5 - 2.0 x N	2.1 - 5.0 N	> 5.0 x N

Hypercalcaemia (mg/dl)	< 10.6	10.6 - 11.5	11.6 - 12.5	12.6 - 13.4	13.5

Hypocalcaemia (mg/dl)	> 8.4	8.4 - 7.8	7.7 - 7.0	6.9 - 6.1	6.0

Hypomagnesaemia (mg/dl)	> 1.4	1.4 - 1.2	1.1 - 0.9	0.8 - 0.6	0.5

Gastrointestinal
Nausea	none	able to eat reasonable intake	intake significantly decreased but can eat	no significant intake	__

Vomiting	none	1 episode in 24 hrs	2 - 5 episodes in 24 hrs	6 - 10 episodes in 24 hrs	> 10 episodes in 24 hrs or requiring paren- teral support

Diarrhoea	none	increase of 2 - 3 stools / day over pre-Rx	increase of 4 - 6 stools / day, or nocturnal stools, or moderate cramping	increase of 7 - 9 stools / day, or incontinence, or severe cramping	increase of > 10 stools / day or grossly bloody diarrhoea, or need for paren- teral support

Stomatitis	none	painless ulcers, erythema, or mild soreness	painful erythema, oedema, or ulcers but can eat solids	painful erythema, oedema, or ulcers and cannot eat solids	requires paren- teral or enteral support for alimentation

Liver
Bilirubin (N = 17 �mol/L)	WNL	-----	< 1.5 x N	1.5 - 3.0 x N	> 3.0 x N

Transaminase (SGOT, SGPT)	WNL	2.5 x N	2.6 - 5.0 x N	5.1 - 20.0 x N	> 20.0 x N

Alk Phos or 5 nucleotidase	WNL	< 2.5 x N	2.6 - 5.0 x N	5.1 - 20.0 x N	> 20.0 x N

Liver- clinical	No change from baseline	-----	-----	precoma	hepatic coma

Kidney, bladder
Creatinine	WNL	< 1.5 x N	1.5 - 3.0 x N	3.1 - 6.0 x N	> 6.0 x N

Proteinuria	No change	1 (+) or < 0.3 g% or 3 g/L	2 - 3 (+) or 0.3 - 1.0 g% or 3 - 10 g/L	4 (+) or > 1.0 g% or > 10g/L	nephrotic syndrome

Haematuria	Negative	microscopic only	gross, no clots no Rx needed	gross and clots bladder irrigation	requires trans- fusion or cystectomy

Weight gain/ loss	< 5.0 %	5.0 - 9.9 %	10.0 - 19.9 %	20.0 %	-----

Pulmonary	none or no change	asymptomatic, with abnormal- ity in PFTs	dyspnoea on significant exertion	dyspnoea at normal level of activity	dyspnoea at rest

Cardiac
Cardiac arrhythmias	none	asymptomatic, transient, requiring no therapy	recurrent or persistent, no therapy required	requires treatment	requires moni- toring; or hypo- tension, or ventricular tachycardia or fibrillation

Cardiac function	none	asymptomatic, decline of resting ejection fraction by less than 20 % of baseline value	asymptomatic, decline of resting ejection fraction by more than 20 % of baseline value	mild CHF, responsive to therapy	severe of refractory CHF

Cardiac ischaemia	none	non-specific T- wave flattening	asymptomatic, ST and T wave changes suggesting ischaemia	angina without evidence of infraction	acute myocardial infarction

Cardiac- pericardial	none	asymptomatic effusion, no itervention required	pericarditis (rub, chest pain, ECG changes)	symptomatic effusion; drainage required	tamponade; drainage urgently required

Hypertension	none or no change	asymptomatic, transient increase by greater than 20 mm Hg (D) or to > 150 / 100 if previously WNL. No treatment required.	recurrent or persistent increase by greater than 20 mm HG (D) or to > 150 / 100 if previously WNL. No treatment required.	requires therapy	hypertensive crisis

Hypotension	none or no change	changes requiring no therapy (incl- uding transient orthostatic hypo- tension)	requires fluid replacement or other therapy but not hospitalisation	requires therapy and hospitalisation; resolves within 48 hours of stopping the agent	requires therapy and hospitalis- ation for > 48 hrs after stopping the agent

Neurologic
Neuro: sensory	none or no change	mild paraesthesias; loss of deep tendon reflexes	mild or moderate objective sensory loss moderate paraesthesias	severe objective sensory loss or paraesthesias that interfere with function	-----

Neuro: motor	none or no change	subjective weak- ness; no objective findings	mild objective weakness without significant impair- ment of function	objektive weak- ness with impairment of function	paralysis

Neuro: cortical	none	mild somnolence or agitation	moderate somnolence or agitation	severe somnolence, (>50 % waking hours), agitation, confusion, disorientation or hallucinations	coma, seizures, toxic psychosis

Neuro: cerebellar	none	slight incoordination, dysdiadochokinesia	intention tremor, dysmetria, slurred speech, nystagmus	locomotor ataxia	cerebellar necrosis

Neuro: mood	no change	mild anxiety or depression	moderate anxiety or depression	severe anxiety or depression	suicidal ideation

Neuro: headache	none	mild	moderate or severe but transient	unrelenting and severe	-----

Neuro: constipation	none or no change	mild	moderate	severe	ileus > 96 hrs

Neuro: hearing	none or no change	asymptomatic, hearing loss on audiometry only	tinnitus	hearing loss interfering with function but correctable with hearing aid	deafness not correctable

Neuro: vision	none or no change	-----	-----	symptomatic subtotal loss of vision	blindness

Pain	none	mild	moderate	severe	reg. narcotics

Skin	none or no change	scattered macular ot papular eruption or erythema that is asymptomatic	scattered macular or papular eruption or erythema with pruritus or other associated symptoms	generalised symptomatic macular, papular or vesicular eruption	exfoliative dermatitis or ulcerating dermatitis

Alopecia	no loss	mild hair loss	pronounced or total hair loss	-----	-----

Allergy	none	transient rash, drug fever < 38^oC (100.4^oF)	urticaria, drug fever 38^oC (100.4^oF), mild bronchospasm	serum sickness, bronchospasm requiring parenteral medication	anaphylaxis

Local	none	pain	pain and swelling with inflammation or phlebitis	ulceration	plastic surgery indicated

Fever of unknown origin	none	37.1 - 38.0^o C 98.7^o - 100.4^o F	38.1 - 40.0^oC 100.5 - 104^oF	> 40.0^oC > 104.0^oF for less than 24hrs	> 40.0^oC (>104^oF) for more than 24 hrs or accompanied by hypotension

Infection	none	mild	moderate	severe	life-threatening

WNL = Within normal limits

Additional events
Asthenia	analogous to Karnofsky index (WHO grading)

Chills	analogous to fever

Peripheral oedema	analogous to weight gain

Anorexia	analogous to weight loss

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